TeleWellness Solutions for Chronic Conditions Project Summary Disability and chronic illness cost over $260B every year, including preventable hospitalizations, emergency room visits and secondary conditions such as wounds, urinary tract infections, pneumonia, and sepsis. This proposal describes a telehealth portal linked to smartphone applications (apps) that enable clinicians to remotely monitor and triage the self-care activities of patients. Regardless of their location, and without any specialized equipment, the proposed system cues a user to their self-care routine and records their health status, functioning like a virtual health coach to promote self-management. A suite of apps, customized to the needs of an individual patient, will allow patients to alert clinicians when new problems arise (e.g. symptoms of a urinary tract infection), report specifics about their medical problems (e.g. size of a pressure sore), ask questions, refill medications, make appointments, or seek medical advice. It will automatically send reports when gaps in care arise (e.g. neglect of bowel management routines). Clinicians could utilize the system as part of their existing workflow to monitor the self-care activities being completed by patients, receive alerts when problems arise, triage large groups of patients, and intervene quickly through two-way communication. This system has the potential to not only improve the patients' quality of care and adherence to recommendations, but also increase efficiency of healthcare personnel. Pilot work through the Rehabilitation Engineering Research Center on Telerehabilitation resulted in a suite of apps (medication management, urinary care, bowel management, mood tracking, and skin/wound care) designed for a demonstration cohort with spina bifida, along with a preliminary web-based portal to provide a clinician with access to data. The transmitted data are secure, archived, and sent via standard messaging communications protocols. This proposal addresses transfer of this pilot system to a commercial product, including extension to additional populations of persons with chronic conditions and evaluation of the portal for use by clinicians. In Phase I, a pilot version of the web portal will be iteratively redesigned with ongoing feedback from clinical consultants and clinicians participating in usability trials. Clinical case managers from medical centers and community-based organizations serving people with diverse chronic disabilities will be recruited to participate in a five-stage iterative design process, providing feedback on how the system would fit into clinical workflow, what features would improve usefulness, and what usability problems need to be addressed. The final Phase I version of the apps will also be evaluated in usability trials with 16 individuals with chronic disabilities. Data from usability trials for clinicians and people with disabilities, including user performance and user ratings, will be evaluated against benchmarks for Phase I success. Following usability trials, a design plan will be developed for the Phase II system, which will be reviewed by clinical consultants to determine whether the Phase II design plan includes features which will make the final system practical and beneficial in a clinical environment. Phase II goals will be to ensure that the system is secure and robust for real-world, high-volume deployment; and to evaluate clinical efficacy of the final system.